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Understanding Your Coverage

It’s easy to find yourself confused by the medical insurance jargon you may encounter when trying to choose a health insurance plan. Familiarize yourself with the basics to help you find the one that best meets your needs.

Out-of-network services are services received from a physician or specialist who is not in your health insurance plan’s network. You will likely have to meet a higher deductible and pay a higher co-pay or co-insurance amount when you see an out-of-network provider. Some plans may not cover out-of-network services at all. Review your plan documents for specific details about out-of-network coverage.

Questions to Ask When Choosing a Plan

Is my doctor in the health plan network? Many health insurance companies establish provider networks. These networks include doctors, hospitals and other health care providers that have contracted with the health plan to provide care at special rates.

What is the most I am at risk to pay for the year? Add up your total expected out-of-pocket costs. This includes your payroll contributions, co-payments for office visits or medications, and your annual deductible. Some insurance companies and employers offer estimator tools to help you determine your costs for the coming year. If you have a choice of plans, think about which payment method is more comfortable for you. For instance, would you be comfortable paying higher premiums and lower deductibles or the other way around?

What does the plan cover? Make sure the plan gives you peace of mind. You will want to know which services are covered if something unexpected happens. Look for preventive care, doctor visits, hospital stays, and emergency room coverage to name a few.

What are the extras that come with the plan and are they free? Spend a few minutes to understand any extras the plan may offer. This can include discount programs, wellness programs, 24-hour nurse support, and programs to manage chronic illnesses. These can add up to better care and lower costs for you.